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Heart transplant patients have an increased risk of developing cancer. Patients who underwent HTx between 1985 and 2017 were included. Detection of cancer was obtained by cross-checking the study population with the Swedish Cancer-Registry and the Causeof-Death-Registry. A total of 664 patients were followed for a median of 7.7 years. In all, 231 malignancies were diagnosed in 138 patients. Compared to the general population the excess risk of cancer following HTx was 6.2-fold calculated as the standardized incidence ratio (SIR) and 2.9-fold after exclusion of non-melanoma skin cancer (NMSC). The most common malignancies were NMSC, non-Hodgins lymphoma, and lung cancer. There was no significant difference in overall survival between those with and without a history of cancer before HTx (p = 0.53). During a median follow-up of 7.7 years, 19% of HTx recipients developed cancer, 6.2-fold higher relative to the general population, and 2.9-fold higher when excluding NMSC. Risk factors for malignancies (excluding NMSC) included previous smoking, hypertension and prolonged ischemic time; and for NMSC, increasing age, seronegative CMV-donors, and azathioprine. A previous cancer in selected recipients results in similar survival compared to those without cancer prior to HTx. [ABSTRACT FROM AUTHOR]

Purpose: The primary goal of this study was to assess the risk of postoperative surgical and medical complications and problems among nonagenarian patients operated with hip arthroplasty. Methods: Data from a specific high-volume arthroplasty clinic, were collected to evaluate postoperative morbidity and complication rates after hip arthroplasty in nonagenarians, compared with a control group of younger, but similar patients. Outcomes evaluated included length of stay, transfusion rate, and postoperative medical and surgical complication rates. Results: A total of 97 nonagenarian patients (mean age 91.4 years) were included, and compared with 89 control group patients (mean age 70.18 years). Nonagenarian patients had significantly longer length of stay (11.44 vs. 7.98 days, p < 0.01), significantly higher risk of needing a transfusion (11.30% vs. 3.40%, p = 0.04), and significantly higher risk of a postoperative medical complication (28.90% vs. 11.20%, p = 0.03). There was no difference in postoperative surgical complication rate (7.20% vs. 2.20%, p = 0.12). Conclusion: Nonagenarian patients, when compared to a younger control group, experience significantly longer hospital stays, and risk of non-surgical complications. Arthroplasty in nonagenarian patients carries with it a high risk of complications, and thus careful pre-operative evaluation and the care of these patients at high volume, specialized clinics is important to optimize outcomes. Level of evidence: Level III retrospective cohort analysis. [ABSTRACT FROM AUTHOR]

Background: Patients with chronic kidney disease (CKD) and significantly low estimated glomerular filtration rate (eGFR) or end-stage kidney disease have been linked to thyroid dysfunction. Renal function is also negatively impacted by thyroid disease. Aims and Objectives: This study was conducted to find out magnitude of thyroid disorder in advanced CKD and to correlate eGFR with thyroid function status. Materials and Methods: A hospital-based study was conducted among CKD patients to assess the thyroid disorders and its associated factors. A thorough clinical history was taken on chief complaints, any additional precipitating factors or co-morbidities (such as diabetes and hypertension), the use of any medications other than those for CKD in the past, any significant surgical procedures, and any episodes of hemodialysis. A morning blood sample was collected for thyroid function (T3, Free T3, T4, Free T4, and thyroid-stimulating hormone [TSH]) and kidney function test. According to KDIGO’s criteria 2017, CKD was identified. Results: The current study included 60 individuals, with a majority of men (56.7%) and a mean (SD) age of 48.8 (8.4) completed years. 28.3% had low T3 syndrome. Hypothyroidism was seen by 15% and 28.3% had subclinical hypothyroidism. There was no identified hyperthyroidism patient. eGFR had positive correlation with free T3 (r=0.46, P=0.0002). It had a low positive (r=0.03, P=0.7) and weakly positive (r=0.14, P=0.2) correlation with total T3 and total T4. Free T4 and TSH both had negative correlations with eGFR (r=−0.17, P=0.1 and r=−0.09, P=0.4, respectively). Conclusion: Patients with CKD had non-specific thyroid impairment, or decreased total T3 alone but no hyperthyroidism at presentation. The progression of CKD stage made it worse. There was significant positive correlation between free T3 and eGFR.

Introduction: Arteriovenous fistula (AVF) is a primary dialysis vascular access commonly used for maintaining hemodialysis (MHD) patients. Vitamin D (VD) is a fat‐soluble steroid hormone that is closely related to vascular endothelial function. This study aimed to investigate the association between VD metabolites and AVF failure in patients undergoing HD. Methods: This study included 443 HD patients using AVF between January 2010 and January 2020. The AVF operations in these patients were newly created by the same physician. We analyzed the AVF patency rates using the chi‐square test. Univariate and multivariate logistic regression analyses were performed to explore risk factors for AVF failure. Survival analysis was performed to explore AVF survival at different serum 25‐hydroxyvitamin D (25(OH)D) concentrations. Results: Logistic regression analyses showed that male sex; age; BMI; serum albumin, triglyceride, phosphorus, 25(OH)D, iPTH and hemoglobin levels, history of hypertension, CHD, diabetes, stroke, and antiplatelet drug use; and smoking habits were not risk factors for AVF failure. The failure incidence rates of AVF in subjects in the VD deficiency and non VD deficiency group were not statistically significant (25.0% vs. 30.8%, p = 0.344). The AVF failure incidence rates at 1, 3, and 5 years in the patients with 25(OH)D levels more than 20 ng/mL were 26%, 29%, and 37%, respectively, and the one‐year AVF failure incidence rates were 27% in the patients with 25(OH)D levels less than 20 ng/mL. In addition, the Kaplan–Meier analysis suggested that the no significant differences were noted when calculating the cumulative survival rates of AVF between the two groups within 50 months of AVF using. Conclusion: Our findings suggest that 25(OH)D deficiency is not associated with AVF failure incidence rates, and that 25(OH)D deficiency has no significant impact on long‐term cumulative AVF survival rate. [ABSTRACT FROM AUTHOR]

Background: Patients with chronic kidney disease (CKD) and significantly low estimated glomerular filtration rate (eGFR) or end-stage kidney disease have been linked to thyroid dysfunction. Renal function is also negatively impacted by thyroid disease. Aims and Objectives: This study was conducted to find out magnitude of thyroid disorder in advanced CKD and to correlate eGFR with thyroid function status. Materials and Methods: A hospital-based study was conducted among CKD patients to assess the thyroid disorders and its associated factors. A thorough clinical history was taken on chief complaints, any additional precipitating factors or co-morbidities (such as diabetes and hypertension), the use of any medications other than those for CKD in the past, any significant surgical procedures, and any episodes of hemodialysis. A morning blood sample was collected for thyroid function (T3, Free T3, T4, Free T4, and thyroid-stimulating hormone [TSH]) and kidney function test. According to KDIGO's criteria 2017, CKD was identified. Results: The current study included 60 individuals, with a majority of men (56.7%) and a mean (SD) age of 48.8 (8.4) completed years. 28.3% had low T3 syndrome. Hypothyroidism was seen by 15% and 28.3% had subclinical hypothyroidism. There was no identified hyperthyroidism patient. eGFR had positive correlation with free T3 (r=0.46, P=0.0002). It had a low positive (r=0.03, P=0.7) and weakly positive (r=0.14, P=0.2) correlation with total T3 and total T4. Free T4 and TSH both had negative correlations with eGFR (r=-0.17, P=0.1 and r=-0.09, P=0.4, respectively). Conclusion: Patients with CKD had non-specific thyroid impairment, or decreased total T3 alone but no hyperthyroidism at presentation. The progression of CKD stage made it worse. There was significant positive correlation between free T3 and eGFR. [ABSTRACT FROM AUTHOR]

Background: Nosocomial infections (NI) also termed as healthcare-associated infections (HCAIs) include infections that are acquired from a hospital or other health care centers, which appear for the first time within 48 hours of hospital admission, 3 days of discharge or 30 days of operation. However, in some cases, the NIs occur within 30 days after discharge, such as surgical site infections. Aim of the Work: Primary aim: Identifying the frequency and risk factors of major and minor infection in the early postoperative course of pediatric cardiac surgery. Secondary Aim: Identifying the most prevalent isolated microorganisms and the antimicrobial susceptibility pattern. Tertiary Aim: Highlighting the points of improvement to reduce the incidence of post-operative infection in the center of study. Patients and Methods: This study is a prospective cohort observational study conducted on patients who were admitted at post-operative Cardiac Pediatric Intensive Care Unit at Ain Shams University Hospitals over 6 months from May 2022 to November 2022. Results: The study included 60 pediatric patients (32 males and 28 females) who underwent cardiac surgical intervention for congenital heart disease with ages ranging from 1 to 168 months and a median age of 30 months (IQR between 12 and 108 months). Out of 60 patients, 15% had postoperative major infections, 13.3% had minor infections and the rest (71.7%) developed neither major nor minor infection during the early post-operative period. The most common risk factors of infection (either major or minor) were the long duration on mechanical ventilation, central venous catheterization and postoperative need for blood transfusion (packed RBCs, plasma, PLT transfusion). Of the 350 collected culture samples;23 were positive (incidence 6.5%). The most common isolated gram positive organisms were staph aureus (incidence 1.1%), the most common isolated gram negative organisms were Klebsiella ssp (incidence 2.2%) followed by acintobater cepacia (incidence 1.4%) then E. coli (incidence 1.1%). No isolation of fungal infection was found. Regarding antimicrobial susceptibility pattern of these microorganisms, we found that they were sensitive to different spectrum of antibiotics. Factors assessing in decreasing the risk factors of major and minor infections during post-operative period included: early diagnosis of the type of organism responsible for nosocomial infection and early treatment with suitable antibiotics. Conclusion: Major postoperative infections caused adverse outcomes in pediatric cardiac surgery and were associated with longer hospital stay. Blood components transfusions, duration of mechanical ventilation and central venous catheterization were associated with higher rates of nosocomial infections. [ABSTRACT FROM AUTHOR]

Objective: Primary pulmonary synovial sarcoma (PPSS) is extremely rare. This study aims to identify the clinicopathologic and therapeutic factors determining survival in PPSS. Methods: We performed a retrospective analysis of 121 patients from the Surveillance, Epidemiology, and End Results Database as well as 12 patients from our own institution diagnosed with PPSS. Patient survival was evaluated using the Kaplan-Meier method. Results: The median survival time for 12 PPSS patients in our institution was 78 months. Postoperative chemotherapy (P = .027 for overall survival and P = .035 for disease-specific survival) was associated with superior survival, whereas pneumonectomy (P = .011 for overall survival and P = .006 for disease-specific survival) was associated with worse survival. Single lobe involvement (P = .022) and the absence of lymph node involvement (P = .045) were associated with improved disease-specific survival and overall survival, respectively. In the Surveillance, Epidemiology, and End Results Database, the median survival time was 23 months. Significantly superior survival was observed in patients with earlier American Joint Committee on Cancer stage (Ⅰ-Ⅱ) (P

Forefoot osteomyelitis can be an extremely challenging problem in orthopedic surgery. Unlike conventional methods, such as amputations, antibiotic impregnated cement space (ACS) was recently introduced and perceived as a substitute for amputation. The purpose of this study was to compare clinical features between diabetic and non-diabetic groups and to evaluate the efficacy of ACS in the treatment of forefoot osteomyelitis, by identifying the clinical characteristics of ACS. We inserted ACS into the forefoot osteomyelitis patients and regularly checked up on them, then analyzed the clinical features of the patients and failure reasons, if ACS had to be removed. Average survival rate of ACS was 60% (21 out of 35 cases) and main failure reason was recurrence of infection. There was no significant clinical difference between diabetic and non-diabetic groups. We concluded that ACS could be a possible way of avoiding amputation if infection is under control. ACS seems to be an innovative method with promising results for foot osteomyelitis, but widely accepted indications need to be agreed upon. [ABSTRACT FROM AUTHOR]

Abstract The aim of this study was to identify the clinical features and prognosis of monoclonal gammopathy of undetermined significance (MGUS) in China. This single center study enrolled 111 subjects visited in Peking University People's hospital including 62 males and 49 females. Among them, IgG subtype, IgA subtype and IgM subtype were 56.31%, 28.16%, 5.83% respectively. 10.7% patients had the abnormality of convectional cytogenetic testing, while the interphase fluorescence in situ hybridization (FISH) made the positive rate increased to 18.9%, and IgH rearrangement was most common. The positive rate of MAGE-C1/CT7 was 73.8% in MGUS, but the expression level was 0.33%, lower than that in MM. After a median follow-up of 15.9 months, 5 cases were determined disease progression (PD), and 1 patient had died of disease progression, two died of the complication. MGUS is becoming increasingly important in China. Male had higher prevalence of MGUS, the most common subtype was IgG, and the IgA subtype was much higher which may be related to the air pollution. MGUS patients had a high positive rate of MAGE-C1/CT7 gene, but the expression level was low. Some patients with MGUS could progress to MM, systemic amyloidosis and other malignant diseases. [ABSTRACT FROM AUTHOR]

Background: An arthroplasty registry in Germany has been recently established but long-term results for most short-stem innovations are missing. Short-stem hip arthroplasty is usually indicated in young active patients. Our indication was extended to older age groups, femoral neck fractures (FNF), and dysplasia. We evaluated all total hip arthroplasties (THAs) in this population with a collum femoris preserving stem (CFP) performed from 2003 to 2013.Methods: A consecutive cohort of 1217 CFP THAs with a mean age of 68.7 years was followed retrospectively for a median of 4.8 years (patient follow-up interquartile range from 3.0 to 6.9 years). A questionnaire, which we used in two previous studies, was answered by 89.15% of patients and included information regarding complaints, grade of satisfaction, re-operations, and dislocation. Of the 1217 patients, 77 had died. Survival of the stem and the cup was assessed using a competing risks approach according to an Aalen-Johanson estimator with revision for septic or aseptic loosening or death as a competing endpoint.Results: Of the patients who answered the questionnaire, 92.5% had no complaints related to the procedures. In all 1217 patients, there were 43 revisions (4.2%) as follows: stem and cup revisions due to aseptic loosening of the stem (n = 10), infections (n = 6), pain (n = 4), or trauma (n = 3); cup revisions due to aseptic loosening (n = 3), dislocation (n = 5), and offset revisions (n = 12). Survivorship was 96% for the stem and 99% for the cup 9 years postoperatively. Statistical analysis confirmed a higher risk for revision in patients with a younger age (p = 0.033), male sex (p = 0.040), dysplasia (p = 0.032), and undersized or extra-large stems for stem revisions (p = 0.001) and female sex (p = 0.036) for cup revisions. FNF (p > 0.20) and age ≥ 80 years (p = 0.114) had no higher risk for loosening of the stem. Our data is also compared with the current literature, especially with the available CFP studies.Conclusion: The survival rate of the CFP stem was as high as 96% after 9 years of followup which compares well-to-previously published long-term survival rates. There is no higher risk for revision in patients 80 years old or older and in cases with femoral neck fractures. The CFP preserves also allowed using standard stems in the rare cases of revision. [ABSTRACT FROM AUTHOR]

Primary gastric lymphomas are the most common extranodal non-Hodgkin’s lymphomas and are divided into indolent (low grade) and aggressive (high grade) types. They are mainly the disease of middle age, with a male predominance reported by most of the studies. For several years, surgery played a central role in diagnosis, staging, and treatment of this entity, yet recently there has been a move away from a surgical approach to conservative treatment. To determine the role of surgery as the initial treatment modality, we performed this retrospective single-center research on 245 patients with primary gastric lymphoma who were treated according to our protocol between 1990 and 2003. The patients’ characteristics, distribution of histological types, treatment results, and disease-specific survival were followed. According to the histology, 59.2% had diffuse large B-cell lymphoma (DLCL), 26.1% MALT lymphoma, 9.8% mixed lymphoma (indolent and aggressive at the same time), while other types were infrequent. In total, 161 patients (65.7%) were treated with surgical resection as the initial treatment, which was then followed or not by additional therapy (chemotherapy, chemotherapy and radiotherapy, radiotherapy) depending on the histological type of lymphoma and the extent of residual disease after surgery. In 84 patients (34.3%), the treatment approach was conservative. The selection of treatment (chemotherapy, chemotherapy and radiotherapy, radiotherapy or Helicobacter pylori eradication only) was based on the histological type of lymphoma, considering also the patients’ physical condition. The disease-specific survival in the group of patients who underwent surgery was statistically significantly better than in patients who were treated conservatively ( p=0.049). At 5 years, it was 96.9% for the group treated with surgery and 89.8% in patients treated conservatively. However, the results were biased, as the patients who were treated conservatively were either in a worse performance status or presented with a more extensive disease. Similarly, in the DLCL type the disease-specific survival was better in the surgically treated group (97.2%) than in the conservatively treated patients (89.2%). The difference was barely significant ( p=0.046) and again the results have to be considered with caution due to the selection of patients in a worse performance status or with a more extensive disease for conservative treatment. In the MALT lymphoma and mixed lymphoma types, there were no differences in the disease-specific survival between both treatment groups. Regarding the statement that for conservative treatment patients were selected who were unsuitable for the resection on account of concomitant diseases or due to the fact that the process was inoperable, we believe that the conservative approach gives comparable outcomes to the approach including initial surgery. The existing evidence thus no longer justifies surgery as the standard initial treatment and preference should be given to conservative treatment approaches. [ABSTRACT FROM AUTHOR]